First Name:

Last Name:

Email:

Address:

City:

Country:

Province/State:

Postal/Zip Code:

Phone:

Sex

Health Concerns/Comments:

Date Of Birth:

Parent/Guardian:

I, the undersigned, agree to release the Markham Regional Ringette Association (MRRA) and its officers, officials, instructors and all persons associated with the organization, from any and all claims in respect of any damage or injury arising from participation in the program by the above-named participant(s).

I, the undersigned, hereby give consent to the above-named participant(s) being:

Interviewed

Photographed

Audiotaped

Videotaped

First Time Playing Ringette?:

I would like to play with (house league only).

Level:

Team Registering For:

The Association is organized by volunteers. If you would like to volunteer please let us know. Volunteers qualify for OSS community service. I would like to volunteer with